DSTU2 Ballot Source

This page is part of the FHIR Specification (v0.5.0: DSTU 2 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Explanationofbenefit-example.xml

Raw XML (canonical form)

General Person Primary Coverage Example (id = "R3500")

Raw XML

<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
  <id value="R3500"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div>
  </text>
  <identifier>
    <system value="http://www.BenefitsInc.com/fhir/eob"/>
    <value value="987654321"/>
  </identifier>
  <request>
    <reference value="http://www.BenefitsInc.com/fhir/oralhealthclaim/15476332402"/>
  </request>
  <outcome value="complete"/>
  <disposition value="Claim settled as per contract."/>
  <created value="2014-08-16"/>
  <organization>
    <reference value="Organization/2"/>
  </organization>
  <requestOrganization>
    <reference value="Organization/1"/>
  </requestOrganization>
</ExplanationOfBenefit>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.